OLR Bill Analysis

sHB 5617 (as amended by House “A”)*

AN ACT MAKING REVISIONS TO THE CHARTER OAK HEALTH PLAN.

SUMMARY:

This bill requires the Charter Oak Health Plan (COHP), a health insurance program established in 2007 and scheduled to be operational on July 1, 2008, to include comprehensive mental health coverage that is consistent with the state's mental health parity law as it applies to group health insurance plans.

*House Amendment “A” eliminates everything from the original bill (File 671) except for the mental health parity provisions.

EFFECTIVE DATE: July 1, 2008

MENTAL HEALTH PARITY

The bill requires the Department of Social Services (DSS) commissioner to ensure that the COHP includes comprehensive mental health coverage, which must be consistent with the state's mental health parity law as it pertains to group health insurance plans.

Under the parity law, no group insurance policy can establish any terms, conditions, or benefits that place a greater financial burden on an insured person for accessing services to diagnose or treat “mental or nervous” conditions than it would for medical, surgical, or other physical health conditions.

BACKGROUND

COHP

PA 07-2, June Special Session, established COHP, and permitted DSS to enter into contracts to provide comprehensive health care for the uninsured. The act allows DSS to charge cost sharing, as well as establish a maximum $ 1 million lifetime benefit. And it provides premium assistance for individuals with incomes less than 300% of the federal poverty level (currently $ 52,800 for a family of three).

The commissioner must determine minimum requirements for COHP benefits' amount, duration, and scope, which cannot include a pre-existing condition exclusion.

DSS issued a request for proposals earlier this year.

Mental Health Parity (CGS 38a-514)

The law defines “mental or nervous conditions” as mental disorders, as used in the American Psychiatric Association's most recent Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR (fourth edition, text revision). It specifically excludes (1) mental retardation; (2) learning, motor skills, communication, and caffeine-related disorders; (3) relational problems; and (4) additional conditions not otherwise defined as mental disorders in the DSM-IV-TR.

The law permits, based on certain conditions, coverage for services provided by psychologists, social workers, marital and family therapists, alcohol and drug counselors, and residential treatment facilities.

Related Bill

sHB 5618 (File 338) mandates that any contracts that DSS enters into to purchase insurance for Medicaid and HUSKY recipients be separate and independent from any contract for providing health care services under COHP.

COMMITTEE ACTION

Human Services Committee

Joint Favorable Substitute Change of Reference

Yea

13

Nay

5

(03/18/2008)

Appropriations Committee

Joint Favorable

Yea

35

Nay

17

(03/28/2008)